Payment for Pharmacist's Patient Care Services
Payment for Pharmacist's Patient Care Services are not included in key sections of the Social Security Act (SSA), which determines eligibility for health care programs such as Medicare Part B. In the case of Medicare Part B, the omission of Payment for Pharmacist's Patient Care Services limits Medicare beneficiaries’ access to pharmacists’ services in the outpatient setting. Pharmacists have demonstrated their value while playing a crucial role in COVID-19 pandemic response by being available and accessible as front-line health care professionals. APhA encourages Congress to pass legislation that recognizes Payment for Pharmacist's Patient Care Services in Medicare Part B and as integral members of the health care team to provide patients with access to and coverage for our quality patient care services.
Pharmacist and Pharmacy Payment
Reform
The pharmacy reimbursement and drug
pricing scheme in the U.S. has grown
out of control, with misaligned
incentives that neither benefit the
patient nor lead to better health
outcomes. These misalignments are
causing pharmacies across the
country to shut their doors, leaving
patients without access to their
local pharmacies. APhA supports
transparency and accountability in
reimbursement and pricing and is
thus concentrating policy efforts to
1) support pharmacists’ ability to
focus on patient care and to be
appropriately paid for these
services and 2) reform pharmacy
payment and PBMs’ actions and
activities that are disrupting the
pharmacy ecosystem. Recent advocacy
and
legal action
led to CMS issuing a final rule that
eliminates harmful retroactive
direct and indirect remuneration
(DIR) fees.
Other Improvements to Medicare
As scientific innovation leads to
medications that are exponentially
more complex, we believe that
pharmacists, as the medication
experts, need to be key players on
patient health teams. APhA advocates
for the expansion and enhancement of
the Medicare Part D Medication
Therapy Management (MTM) program.
Further, APhA supports CMS’s efforts
to increase patient access and
choice by requiring Part D plans and
pharmacy benefit managers (PBMs) to
contract with any pharmacy willing
to accept the PBM’s contractual
terms and conditions for network
participation (i.e. “any willing
pharmacy” requirement). In addition,
APhA will continue to advocate for
increased transparency regarding
Part D plans, including efforts to
provide beneficiaries with
up-to-date information about actual
access standards and cost-sharing
information.
Compounding
APhA urges policymakers to defer to
existing state laws related to
traditional compounding, including
laws related to “office-use,” and
has asked FDA to clarify that its
guidance is not designed to infringe
on the practice of pharmacy as
historically regulated by the
states. APhA also remains concerned
that arbitrary limitations on the
out-of-state distribution of
compounded drug products may
adversely impact patient access to
medically-necessary medications.
Reproductive Health Care
APhA is committed to advancing equitable access to comprehensive reproductive health care for all patients. The association advocates for policies that ensure access to essential reproductive services and opposes legal actions against pharmacies and pharmacists who provide care within their scope of practice. APhA strives to ensure that pharmacists play a vital role in facilitating informed, patient-centered reproductive health care.